92 ADDRESS 



of obstetrics by mid wives or else have opposed any regulation 

 of the practice to secure better conditions, and I apprehend that 

 methods to improve these conditions will encounter to a certain 

 degree opposition on the part of practicing physicians of the 

 country, but it is wrong for us to be blind to the existing condi- 

 tions. As a matter of fact, a large part of this practice is in 

 the hands of midwives. The investigation of the actual con- 

 ditions is as yet a very imperfect matter in this country. Four 

 years ago Miss Crowell made a very notable investigation of the 

 conditions surrounding midwifery practice in New York. She 

 later directed a similar investigation in Chicago, and Dr. Mary 

 Sherwood has reported the results of such a study for Baltimore. 



We know that in a certain class of the population between 

 80 and 90 per cent, of the births are attended by midwives; 

 that is true of the Italian part of the population, the Slavs and the 

 Germans; the immigrant population are accustomed to it. It 

 is a condition which actually exists and cannot be done away 

 with, and we must recognize that as a fact. The investigations 

 also brought out conditions which, I believe, are not more 

 deplorable than is to be expected in view of the lack of require- 

 ment as to what the qualifications of midwives shall be. They 

 brought out appalling conditions, to be sure, but I do not think 

 they are any worse than one would have expected from the 

 fact that there is no control of midwives in this country, at least no 

 adequate control. Very few States have any legislation on the 

 subject at all, and I know of no State that has entirely satis- 

 factory legislation on the subject. We secured at the last ses- 

 sion of our Legislature a fairly satisfactory midwifery Act. It 

 remains to be seen how effective it will prove to be. It is 

 placed in the hands of the State Board of Health. It requires 

 registration and specifies certain qualifications which they must 

 meet. 



There is no place for the midwife to fit herself to pass satis- 

 factory examinations, theoretical and practical, on the subject. 

 One of the great needs unquestionably are schools for the train- 

 ing of midwives in this country. I do not believe there is any 

 question that this is one of the urgent necessities. There are 

 so-called schools in New York and St. Louis, but I do not 

 know that they deserve the name. On the Continent of Europe 

 there are quite thorough training courses, from six months to 

 two years, but in this country what right have we to make 

 these demands in the way of qualifications when we provide 

 no opportunity for the training of midwives? One of the most 

 significant facts brought out from the investigations of Miss 

 Crowell is that even those midwives who come to this country 



